PRIYA LOPEZ
Dependent on policy B04M000892
Claims
3
Attributed to this person
Charged
738.00
Total submitted
Denied
82.00
1 denied claims
Patient responsibility
0.00
Reported on the 835
Patient responsibility is the amount reported on the 835 as assigned to the patient — deductible, coinsurance or copay. It is not proof that the provider billed the member, that the member owes it, or that it was collected, and it is kept separate from denied amounts throughout.
Who this is
| Field | Value |
|---|---|
| Name | PRIYA LOPEZ |
| Role on the policy | Dependent · relationship 19 |
| Policy | B04M000892 |
| Date of birth | 1 Dec 2022 |
| Plan | PLATINUM PPO |
| Covered from | 22 Mar 2025 |
| Covered to | open |
Patient responsibility reported on the 835
No patient responsibility reported on this person's remittances.
Care and denials
| Claim | Service | Charged | Payer | Outcome | Denied |
|---|---|---|---|---|---|
| CLM0003875 | 3 Jul 2026 | 388.00 | CASCADE CARE | Not denied | — |
| CLM0003877 | 20 May 2026 | 268.00 | CASCADE CARE | Not denied | — |
| CLM0003876 | 12 Apr 2026 | 82.00 | CASCADE CARE | CARC 29 · TIMELY_FILING | 82.00 |